The present invention is directed to a surgical device. The present invention is more particularly directed to an introducer for providing a surgical tool with a pathway to a surgical site. The present invention is still more particularly directed to such an instrument for use with surgical devices for robotic surgery, such as for example, robotic neurosurgery.
Surgery has typically involved obtaining access to a region that exposes many aspects of a lesion (e.g. tumor, aneurysm, etc.) allowing its treatment or complete dissection and removal. However, obtaining access to the lesion may also involve damage to areas of the brain or other tissues that are normal. In view of the foregoing, a movement has developed to perform what is called “Minimally Invasive Surgery.” Unfortunately, this, in many instances, is a misnomer since the surgery may or may not be “minimally invasive” both to the critical tissues under consideration, but also to collateral tissues at the site of entry or along the access path. A better term for this type of surgery is “Minimal Access Surgery.” Examples of such surgery include: Endoscopic Surgery, Endoscope Assisted Surgery, Endovascular Surgery, Stereotactic Radiosurgery, etc.
It is often necessary to treat brain tumors and aneurysms in the base of the skull. These are very difficult to treat because accessing the skull base requires disruption of many important structures. It is desirable to minimize the size of any opening to be made through the skull and surrounding, healthy tissues so that pathology in the skull base is treated with the least amount of potential damage to surrounding tissues. Such a procedure could be thought of as “Minimally Disruptive Surgery.” Current endoscopic and endoscope-assisted operations performed on the head, skull base, chest, abdomen, and other areas are done with rigid and straight endoscopes and tools that can only work in a straight line. However, in complex areas such as the brain, the endoscope has to negotiate many obstacles en route (e.g. bone, brain, and blood vessels). This imposes significant restrictions on the surgery being performed and can lead to an increase in collateral tissue damage, due to enlarging the access path and/or damaging or sacrificing the control over the structures near the lesion. Additionally, there are certain types of surgery that are at present not possible given the limitations posed by existing technology.
On the other hand, today's endovascular surgery is often performed over comparatively great distance, and by navigating through a variety of curved channels. Such surgery uses a system of coaxial tubes and actuation cables that work on the basis of forward and backward movement, and side-to-side movement. Such devices are used with real-time imaging that guides the operator to the target. A similar approach is used with flexible endoscopes that work inside the gastrointestinal tract. However, these methods are not applicable for micro scale surgeries, as are performed for intricate neurosurgeries.
In addition to the foregoing, it is sometimes desirable during surgical procedures to irrigate a surgical site, clean surgical tools, or repeatedly remove and reintroduce surgical tools. This presents a problem with currently known robotic surgical systems because removal of the entire system is generally required to change tools.
In answer to the short comings and problems associated with the surgical tools mentioned above, a new and improved surgical device has been under development. This device is shown and described, for example, in co-pending application Ser. No. 12/943,745 (our 2915-001-03) filed Nov. 10, 2010, for SURGICAL DEVICE, which application is incorporated herein in its entirety. The surgical device describe therein is a surgical device capable of steering surgical tools to surgical sites over curvilinear neurosurgery paths to avoid unnecessary damage to sensitive or critical collateral tissue. The device is capable of steering surgical tools around anatomical obstacles while affording the tools complete maneuverability at the surgical site and removal/replacement during neurosurgical procedures.
While such a device represents a significant step forward for neurosurgical applications, the advancement would not be realized unless the surgical device could be delivered to the intended surgical site without causing damage to other tissue. What is thus required is an introducer that is capable of creating a working space for the surgical instrument by retracting adjacent tissue without causing undue trauma. For example, in neurosurgery, the introducer would need to be able to separate brain tissue from dura mater to create a channel to introduce the surgical tool. The tissue displacement must be both active and gentle. The introducer should desirably permit the surgical tools to be used during the surgical tool advancement procedure for visualization, connective tissue cutting and cauterizing in creating the instrument pathway and eventual surgical site. The present invention is directed to these and other issues.